静脉输注免疫球蛋白对呼吸机相关肺炎疗效的系统评价  

Effectiveness of intravenous immunoglobulin for ventilator-associated pneumonia: a systematic review

作　　者：汪成琼 肖政[1,2] 楚亚林[1] 胡世芸[2] 邱隆敏[1,2] 余昌胤[1] 

机构地区：[1]遵义医学院循证医学中心,循证医学教育部网上合作研究中心遵义医学院分中心,贵州遵义563003 [2]遵义医学院附属医院感染科,贵州遵义563003

出　　处：《安徽医学》2015年第7期788-793,共6页Anhui Medical Journal

基　　金：贵州省哲学社会科学规划基金(14GZYB58);遵义医学院博士启动基金(F-617)

摘　　要：目的系统评价免疫球蛋白（IVIG）治疗呼吸机相关性肺炎（VAP）相关研究,分析其有效性,为临床治疗策略提供依据.方法系统检索CNKI、万方、CBM、Pubmed、Embase、ISI及Cochrane数据库中相关文献,采用Cochrane标准评价纳入研究偏倚风险,Meta分析结合描述性分析研究数据.结果①纳入6个随机对照研究,435例低体质量儿、早产儿及婴儿VAP患者,质量一般.②Meta分析结果显示IVIG组死亡率低于非IVIG组[RR=0.33,95%CI（0.18～0.60）,P=0.0002];IVIG组血液免疫球蛋白浓度比对照组高3.19mg/L[MD=3.19,95%CI（3.02～3.37）,P〈0.05];③IVIG组败血症[RR=0.14,95%CI（0.04～0.51）,P=0.003]和多器官功能衰竭发生率[RR=0.51,95%CI（0.30～0.88）,P=0.02]低于对照.结论IVIG主要用于早产儿及低体质量儿VAP患者,可能提高体液免疫,降低败血症和多器官功能衰竭发生率,减少患者病死率,改善预后.Objective To provide the evidences for the clinical strategies through systematically reviewing all related studies and an-alyzing the effectiveness of intravenous immunoglobulin( IVIG) for ventilator-associated pneumonia( VAP) . Methods We retrieved all relat-ed studies in CNKI, Wanfang, VIP, CBM, Pubmed, ISI, Embase and Cochrane library and evaluated the risk of bias by criteria of the Co-chrane Handbook and analyzed all data by meta-analysis. Results Seven RCTs involving 435 low birth weight, preterm or children VAP pa-tients were included, with medium-quality in most trials. ①Meta-analysis results showed that the mortality rate in IVIG group was lower than that in no-IVIG group [RR=0. 33,95%CI(0. 18,0. 60) P=0. 0002]. The immunoglobulin concentrations in IVIG group were 3. 19mg/L higher than those in no-IVIG group [MD=3. 19,95%CI (3. 02,3. 37) P<0. 05]. ② The incidence of sepsis or multiple organ failure in IVIG group was lower than that in non-IVIG group [RR=0. 14,95%CI(0. 04,0. 51) P=0. 003] or [RR=0. 51,95%CI(0. 30,0. 88) P=0. 02]. All had statistical significance. Conclusion IVIG is mainly used for the preterm, low birth weight or children with VAP and may re-duce their mortality and improve their prognosis through enhancing the humoral immunity and decreasing the incidence of sepsis and multiple organ failure.

关 键 词：呼吸机相关肺炎 静脉输注免疫球蛋白 系统评价 

分 类 号：R563.1[医药卫生—呼吸系统]